Utah Health Information Network A Community-Based HIPAA Implementation

1. Utah Health Information NetworkA Community-Based HIPAA Implementation uhin Jan Root, Ph.D. Standards Manager UHIN janroot@uhin.com

2. What is UHIN? • State not-for-profit VAN • Community owned coalition • Owners: • All payers (except) one in the state • UMA, Utah Hosp. Assoc., other providers • State government (Medicaid), others • Business representation • Mission: Reduce the cost of health care through administrative simplification

3. Challenge • Payers: don’t want to spend $ • Do it our way • Competitive, fragmented • Moderate to good IT resources • Providers: don’t want to spend $ • Passive • Disorganized, fragmented • Moderate to poor/non-existent IT resources

4. History • Utah: late 1980’s • Little EDI (only 2 payers – Blue/Medicare) • Other payers wanted to get into EDI • Too small of a market to attract clearinghouses • Each payer was developing their own EDI/DDE system • Providers: We won’t do EDI many different ways • Create one standard and we’ll play ball

5. History • Reluctant coalition formed 1993 • Goal: create an independent agent • Consensus • Seed money: $25,000/member • Bought you a voting seat on the Board • Hired 5 staff in 1993/4 • 1st: Brought up an all-payer institutional billing system (relatively easy) • 2nd:Brought up an all-payer professional billing system (relatively awful) U H I N

6. UHIN e-Connect System - Today Payers: must alter systems to meet standards • Must purchase/ write their own translator Providers: must alter PM systems to meet UHIN standards • UHIN gives providers a translator/e-connect tool • Or providers may use their own translator Must meet the UHIN standards UHIN UHIN: private network • all standard connections

7. UHIN is a VAN Value is Key • VAN – we don’t ‘open the envelope’ • Providers/Payers must use standardized transactions (like HIPAA), standard data • Everyone had to compromise • Must provide value to members • Low EDI cost – initial value • UHIN is a national ‘player’ (WEDi, X12, etc) • UHIN offers free consulting to members

8. All claims UHIN Immediate Value? PROVIDERS • One system to send 60-100% of their claims/receive payments • Responsibility for data quality • All-payer edits in translator: • increased data quality (fewer rejections) • Claims got paid faster • Reduced the cost of submitting claims • Improved business processes Payer A Payer C Payer B

9. Immediate Value? PAYERS • ROI in less than 6 months • Payers who had been doing EDI • Significant increase in claim volume • Began upgrading/redesigning claim payment systems • Purchasing automated adjudication systems designed for EDI • Immediate claim payment (cheaper than using a float) • Re-engineering their business

10. Challenges - Big players Lower long-term costs Initial start-up Maintenance Higher EDI volumes Doing it in a coalition $$ EDI Volume Doing it alone Doing it in a coalition Time

11. The Age of HIPAA $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ • HIPAA makes good business sense • A further opportunity to optimize business processes & reduce costs • Transactions • Eligibility, Claim Status • Privacy • Increasing customer trust • Security • Moving to computerization, to the Internet • UHIN members intend to take full economic advantage of HIPAA to reduce the cost of doing business $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

12. UHIN - Future • UHIN moving to an Internet system • Still ‘generic’ all-payer, all-provider • Offer all HIPAA transactions • (plus some more, e.g., standardized front-end claim acknowledgement) • Will be implementing attachments trxn • Security: • PKI at the organizational level • Apportioning security risk/responsibility

13. UHIN UHIN Benefits - Legal • UHIN created a community-wide electronic commerce agreement (ECA) • Signing UHIN’s ECA satisfies privacy requirement for all trading partners in UHIN. One privacy agreement Many privacy agreements

14. UHIN Benefits – Cost to Members • UHIN owners set rates • Payers: pay per claim (24¢ 12¢) • Providers: pay annual membership fee ($100 $50/year for 1 doc shop) • UHIN is a not-for-profit: must not charge more than they need to operate: lower fees $$$$$$$$$$$$$$$$$$

15. UHIN Benefits - Education • State-wide educational efforts • Business-based HIPAA implementation of the transactions • How to use them to save money • Privacy awareness • Security • Reasonable and appropriate

16. HIPAA Cost Comparison Tool • Simple spreadsheet • Excel or Word • You put in YOUR practice data • Ballparks savings from implementing HIPAA transactions • UHIN data: varies by provider type • www.uhin.com • Education • Tools – HIPAA Cost Comparison Tool • Free HCCT

17. BenefitsUHIN Provider Software • Generic • Based on the HIPAA Standards not on any one member’s needs • (Theoretically) Anyone could use UHIN’s software: • One size fits all • Software handles all HIPAA transactions (and then some) • Used for public health reporting

18. Help!? BenefitsSecurity and the Small Provider • UHIN is a community resource • Obligation to serve small providers • USET = UHIN Security Education Tool • Free to members • Walks user through all requirements of Security NPRM • Help in writing security policy and procedures • Goal: Raise awareness of the importance of security • Reasonable and appropriate security makes good business sense

19. UHIN • Utah Health Information Network • Community-based, State not-for-profit • More information: • www.uhin.com • Jan Root • 801-466-7705 x202 uhin